Adolescents' physical activity and sedentary behaviour in Indonesia during the COVID- 19 pandemic: a qualitative study of mothers' perspectives
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Andriyani et al. BMC Public Health (2021) 21:1864
https://doi.org/10.1186/s12889-021-11931-1
RESEARCH Open Access
Adolescents’ physical activity and sedentary
behaviour in Indonesia during the COVID-
19 pandemic: a qualitative study of
mothers’ perspectives
Fitria Dwi Andriyani1,2*, Stuart J. H. Biddle1 and Katrien De Cocker1,3
Abstract
Background: Socio-behavioural adaptations during the COVID-19 pandemic may have significantly affected
adolescents’ lifestyle. This study aimed to explore possible reasons affecting changes in physical activity and
sedentary behaviour in Indonesian adolescents during the pandemic based on mothers’ perspectives.
Methods: We recruited parents (n = 20) from the Yogyakarta region of Indonesia (July–August 2020) using
purposive and snowball sampling. Individual interviews were audio-recorded, transcribed verbatim and anonymised.
Data were imported into NVivo software for a reflexive thematic analysis.
Results: The interviews lasted between 38 and 113 min (M = 65 min). Participants’ age ranged between 36 and 54
years (M = 42.6 years). Participants’ children ranged in age from 12 to 15 years (M = 13.7 years, female: 9, male: 11).
Themes related to changes in physical activity during the pandemic were 1) self-determination and enjoyment, 2)
supports from others, and 3) physical activity facilities and equipment. Themes related to changes in sedentary
behaviour during the pandemic included 1) educational demands, 2) psychological effects due to the pandemic, 3)
devices and internet availability, 4) parental control, and 5) social facilitators.
Conclusions: During the pandemic, mothers perceived their children to be less active and using more screen-
based devices, either for educational or recreational purposes, compared to before. The present themes might be
useful when developing interventions and policies promoting physical activity and reducing sedentary behaviour in
adolescents. Interventions could, for example, consider increasing parents’ and adolescents’ awareness on current
activity guidelines, providing education on healthier recreational screen time, and involving parents, peers, and
teachers. Increasing the accessibility of physical activity facilities and equipment, making use of adolescents’
favourite program and social media for interventions, and providing activities that are fun and enjoyable may also
important.
Keywords: COVID-19, Health, Youth, Physical activity, Screen time, Sedentary behaviour
* Correspondence: FitriaDwi.Andriyani@usq.edu.au;
fitria.dwi.andriyani@uny.ac.id
1
Physically Active Lifestyles Research Group (USQ PALs), Centre for Health
Research, University of Southern Queensland, Springfield Central 4300,
Australia
2
Department of Sports Education, Faculty of Sports Science, Yogyakarta State
University, Yogyakarta 55281, Indonesia
Full list of author information is available at the end of the article
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data made available in this article, unless otherwise stated in a credit line to the data.Andriyani et al. BMC Public Health (2021) 21:1864 Page 2 of 14 Background distancing and isolating, have caused a significant reduc- It has been widely known that maintaining a sufficient tion in physical activity [18–20], an increased engage- level of physical activity and limiting sedentary behav- ment in sedentary behaviour [19, 21, 22], and disrupted iour are crucial to support both physical and mental sleep schedule [21, 23] among children and adolescents. health in youth [1–4]. For young people, physical activity In the long term, this may accumulate to cause serious was associated with better adiposity profiles, cardiometa- health problems. bolic biomarkers, physical fitness, bone health, cognitive Previous COVID-19 studies on physical activity and function and academic achievement [1, 3]. In contrast, sedentary behaviour have investigated the effects of the sedentary behaviour can be associated with detrimental pandemic on the levels of participation in both behav- health outcomes, including lower fitness and sleep qual- iours [18–20]. Other studies have focused on the effect ity, unfavourable BMI, higher cardiometabolic risk, and of physical activity and sedentary behaviour on health lower psychosocial health [3, 5, 6]. The 2020 World outcomes during the pandemic [24, 25]. Investigations Health Organization (WHO) guidelines recommended on these topics have largely employed cross-sectional de- that children and adolescents (5–17 years) accumulate signs using quantitative questionnaire data [20, 26, 27]; an average of 60 min of moderate-to-vigorous physical these have known limitations, including recall and activity (MVPA) every day and limit the duration of social-desirability bias [28]. Meanwhile, research on the recreational screen time to achieve positive health reasons for changes in adolescents’ physical activity and outcomes [7]. sedentary behaviour during the pandemic by using quali- In December 2019, the first case of severe acute re- tative approaches are not yet available. There is also a spiratory syndrome coronavirus 2 (SARS-CoV-2) paucity of data from low-to-middle income countries (COVID-19) was identified in Wuhan City, China [8]. (LMICs), which is often suffering from a high population Shortly after, the disease began to spread rapidly across prevalence of physical inactivity and sedentary behav- the world. Social distancing and quarantining/isolating iour. A large scoping review revealed that in Indonesia, have become common practices as measures to hamper only 12.2–52.3% of youth report sufficient physical activ- the spread of the outbreak. The general public was en- ity and between 24.5–33.8% have sedentary behaviour couraged to stay at home and to do only essential out- levels ≥3 h/day [29]. door activities, such as grocery shopping. Moreover, as This study, therefore, aimed to investigate reasons af- of March 26, 2020, school closures have been enforced fecting changes in physical activity and sedentary behav- nationwide in 166 countries, affecting over 80% of en- iour in Indonesian adolescents during the COVID-19 rolled students (more than 1.4 billion young people) pandemic based on mothers’ perspectives by using a worldwide [9]. qualitative approach. Parental views were explored as In Indonesia, the first COVID-19 case was confirmed they may provide important information on the determi- on the 2nd of March 2020 [10]. In Yogyakarta region, nants of children’s behaviour [30] and at the same time emergency response status was implemented from provide a narrative on the contexts of children’s behav- March to August 2020 [11]. Even though there was no iour. Investigating adolescents’ physical activity and sed- restriction to do exercise outside the house, communi- entary behaviour during the pandemic through their ties in the region were encouraged to limit their mobility parents’ perception has become a common practice in and public sports facilities were closed during those time existing studies [20, 22, 26, 27]. A previous study indi- [12–14]. School closures have also been enforced from cated that parents may influence children’s physical ac- the end of March 2020 [15]. Since then, students have tivity and sedentary behaviour during the pandemic [22], been studying online at home. hence we sought to examine the underlying factors fur- These changed circumstances may have affected young ther based on the perspectives of mothers. people’s lifestyle profoundly, including their physical ac- tivity and sedentary behaviour. Even before the COVID- Methods 19 pandemic, with the freedom to do activities and ac- This study conformed to the Standards for Reporting cess to public amenities, more than three-quarters (81%) Qualitative Research (SRQR) [31] (See Table S1). of adolescents did not meet the WHO physical activity Grounded in the pragmatism paradigm, we chose a guidelines [16]. In a large review of population studies, qualitative approach to achieve our research objectives. Thomas et al. (2020) reported that over 50% of young Pragmatism is a paradigm that breaks through the di- people exceeded 2 h/day of recreational screen time, chotomy between post-positivism and constructivism with screen time averaging 3.6 h/day [17]. The COVID- [32]. Pragmatists position the research objectives as cen- 19 outbreak may have exacerbated these trends. Prelim- tral and implement all sound methods to answer the inary studies suggested that socio-behavioural adapta- problems [33]. Methods for collecting and analysing data tions during the COVID-19 pandemic, including social were selected for their ability to provide an
Andriyani et al. BMC Public Health (2021) 21:1864 Page 3 of 14
understanding of the research problem without a philo- interview was semi-structured, the interviewer could ask
sophical commitment to specific paradigms [34]. questions beyond those in the interview guide to probe
This study aimed to explore parents’ perspective of for more information and context [40].
underlying reasons thought to affect changes in physical Interviews were conducted primarily by mobile phone,
activity and sedentary behaviour in adolescents during either using conventional phone call, WhatsApp call or
the COVID-19 pandemic. We believe that a qualitative Zoom call as preferred by participants (n = 17). Three
approach is the most appropriate method for achieving participants asked to do face-to-face interviews in the in-
those research objectives as it can facilitate in-depth in- terviewer’s house due to problems with telephone con-
sights, and more multi-layered understanding and inter- nections and convenience reasons. Face-to-face
pretation in investigating real-world problems [35, 36]. interviews were conducted by strictly following the
COVID-19 health and safety protocol, including wearing
Participants masks, and social distancing.
Participants were recruited by using purposive and Interviews were conducted in July and August 2020
snowball sampling [37], to ensure that the potential par- and were audio-recorded by using Olympus Digital
ticipants fulfill the recruitment criteria and to make the Voice Recorder (DS-3500) and Olympus Boundary
recruitment process more efficient, especially during the Microphone (ME33). Each interview was started with
COVID-19 pandemic. To participate in the study, partic- warm-up questions to build rapport with the participant.
ipants had to be parents or caregivers that supervised at The interviewer briefly explained the study and how the
least one adolescent child who studied at junior high privacy and confidentiality of participants were pro-
school level and lived in the Yogyakarta region of tected. Afterwards, the interviewer explained the outline
Indonesia. of the interview and offered opportunities for the partici-
All prospective participants received research informa- pants to ask any questions. Participants could ask to stop
tion packs that explained the details of the study. The the interview at any time and they could refuse to an-
packs were sent to participants either through paper- swer any questions. Participants were offered an oppor-
based mail, e-mail or as a WhatsApp attachment. Par- tunity to review and revise their statement on the
ents that agreed to participate were asked to complete transcript and were given 3 days from receiving the tran-
an online questionnaire that consisted of a consent form script to change their statement. The interviews lasted
and sociodemographic questions, including age, the between 38 and 113 min (M duration = 65 min). Upon
highest education level, employment status, and child’s completion of the interview, participants were offered a
age. The online questionnaire was hosted on the secure grocery voucher valued at AUD ($) 10 as a token of ap-
host University online survey platform. preciation for their time.
Twenty mothers agreed to participate in the study.
Taking into account the heterogeneous nature of the Data analysis
participants’ sociodemographic data, the balance be- All interview recordings were transcribed verbatim and
tween male and female children of the participants, and anonymised. Transcripts were imported into NVivo soft-
the extensive research questions, we believe that this ware (Version 12 Pro, QSR International, Victoria,
number is sufficient (see [38]). Australia).
While “data saturation” has become a standard criter- This study used a reflexive thematic analysis approach
ion in determining the sample size in thematic analysis to analyse data. This is a method for identifying, analys-
research, we did not adopt this practice because of its in- ing and reporting patterns or themes within data, where
compatibility with the reflexive thematic analysis ap- analysis is done after deeply engaging with the data; and
proach that we use in this study (see [38, 39]). In the that themes are actively generated by the researcher as
reflexive thematic analysis approach, coding is an “open, themes do not passively emerge from data [39, 41].
fluid, organic, and recursive practice”, where codes are Themes can be described as specific patterns based on
never fixed and “can evolve, be renamed, split into sev- interpretation across the dataset with a central organis-
eral codes, collapsed together with other codes, and even ing concept [39, 42]. In the reflexive thematic analysis,
be abandoned” [38]. Moreover, coding can also move researcher subjectivity is understood as a resource rather
from the surface (semantic) meaning into more inter- than “a potential threat to knowledge production”, which
pretive (latent) meaning as researchers get more engage reflect the nature of qualitative research that is creative,
with data [38]. reflexive and subjective [39].
The transcripts were analysed by following phases in
Interview the reflexive thematic analysis approach as follows: 1)
Semi-structured one-on-one interviews were conducted Familiarisation with the data, 2) Coding, 3) Generating
by the lead author using an interview guide. As the initial themes, 4) Reviewing themes, 5) Defining andAndriyani et al. BMC Public Health (2021) 21:1864 Page 4 of 14
naming themes, and 6) Writing up [39, 43]. Firstly, the third authors to check for any personal biases. These
lead author (FDA), who interviewed the participants, be- authors are experienced senior academics and re-
came familiarised with and immersed in, the dataset by search supervisors in exercise psychology and public
listening to the interview recordings and reading the health.
transcripts. After that, she conducted the data coding
using the NVivo software. Codes were generated on both Results
semantic and latent level to enable the researcher to ex- The characteristics of the sample are presented in
plore both the surface and the underlying meaning from Table 1. Based on data analysis, we generated three
participants’ voices [41, 43]. themes related to changes in physical activity during the
After data coding, the first author then generated ini- COVID-19 pandemic: 1) self-determination and enjoy-
tial themes by using the inductive approach. The ment to do physical activity, 2) supports from others,
strength of this is to prevent the theme’s generation to and 3) the availability of physical activity facilities and
be driven by the pre-existing theoretical interest of the equipment. The thematic map of these themes can be
researcher [41] that may interfere with the analysis and seen in Fig. 1. Meanwhile, five themes were identified
interpretation of data. The researcher produced themes that related to changes in sedentary behaviour: 1) educa-
without trying to connect them to previously established tional demands during the pandemic, 2) psychological
theories as this may create some barriers for the re- effects due to the impact of the pandemic, 3) devices
searcher to see something “new” and “different”. After- and internet availability, 4) parental control, and 5) so-
wards, all authors critically reviewed themes, including cial facilitators. The thematic map of these themes can
defining and naming themes. Data were analysed be- be seen in Fig. 2.
tween November 2020 and March 2021.
Factors affecting adolescents’ physical activity during the
Researcher characteristics and reflexivity COVID-19 pandemic
The lead author is a PhD candidate and a lecturer at a Self-determination and enjoyment to do physical activity
university Faculty of Sports Science, with previous ex- Overall, parents mentioned that their adolescent chil-
perience of qualitative research methods. She adopted dren did more physical activity before compared with
the pragmatism paradigm which influences her way of during the pandemic. During pre-pandemic school days,
thinking in looking for the most appropriate methods to children were doing physical activity in Physical Educa-
achieve her research objectives [33]. Her philosophical tion lessons and many of them also did physical activity
paradigm shapes her position that she does not want to through participation in extracurricular sports activities
be tied to, or has a philosophical commitment to specific at school or in sports clubs. A majority of mothers of
paradigms [34]. boys reported that before the pandemic their sons were
The lead author conducted all interviews and data engaged in some forms of physical activity after school
analysis. As some of the participants were recruited hours, such as playing football (soccer). Those activities
from personal contacts, this may influence the inter- changed significantly, especially during the beginning
view process and how those participants responded to phase of the pandemic. Children spent most of the time
the interview questions. The pre-established connec- at home due to social distancing and quarantining pol-
tion between the lead author and those participants icy, and naturally became less active.
may facilitate the participants to tell their true stories Self-determination seemed to be a key factor affecting
but may also provide some barriers to reveal stories adolescents’ physical activity during the pandemic. Ado-
due to social desirability bias. The study information lescents who were more active before the pandemic were
sheet may influence participants’ responses to re- reported to maintain some form of physical activity
search questions. Nevertheless, the lead author always during the pandemic, even without direct support from
explained to the participants the need to tell their parents, thus showing forms of intrinsic motivation and
real situation and perspectives and tried to build good self-determination [44]. An example of a more externally
rapport and conversation throughout the interviews. regulated form of self-determination is one overweight
Sharing and living in a similar cultural background in adolescent who was reported to do more physical activ-
the Yogyakarta region of Indonesia may also provide ity during the pandemic as her awareness toward health
some degree of connectedness between the lead au- increased and she had a goal to reduce weight. Another
thor and the participants that make participants feel example is one male adolescent who used to be active in
comfortable to share their stories and may facilitate a sports club was also reported to maintain activity as he
the smoothness of the interviews. was determined to be an elite athlete for financial or
To maintain reflexivity in interpreting data, the lead economic reasons. This is also more externally
author discussed her thoughts with the second and regulated.Andriyani et al. BMC Public Health (2021) 21:1864 Page 5 of 14
Table 1 Characteristics of the interview sample (N = 20) parents of 15 years old male children).
Variables Total % Note: I = Interviewer; P = Participant
Age (Years) M = 42.6 SD = 6.17
35–40 12 60%
Enjoyment – a more intrinsic form of self-
determination - also appeared to support adolescent’s
41–45 2 10%
self-determination in doing physical activity during the
46–50 2 10% pandemic. Many parents reported that their adolescent
51–55 4 20% child did many forms of sports as their hobby before the
Education pandemic. Some months after the pandemic began,
Year 6 1 5% these adolescents were reported to continue doing their
Year 9 2 10%
hobbies because of their enjoyment of the activities.
Some adolescents were also reported to enjoy new phys-
Year 12 8 40%
ical activities during the pandemic, such as cycling with
Bachelor degree 7 35% friends and family members. Some female adolescents
Doctoral degree 2 10% were reported to enjoy participating in dance, such as
Occupation before the pandemic following the popular K-Pop dance on YouTube.
Labourer 3 15%
Lecturer 2 10%
“Yes, (she watched) YouTube, and did dance for two
(or) three songs (I: yup), dance like K-Pop is aerobic,
Housemaid 2 10%
right?” (P1, parents of 13 years old female
Tailor 2 10% children).
Teacher 6 30%
Entrepreneur 2 10% Support from others
On-Call Driver 1 5% Apart from self-determination and enjoyment, the way
Housewife 1 5%
the adolescents did physical activity during the pandemic
appeared to be influenced by support from others (i.e.,
Multi-Occupation 1 5%
family, friends, and teachers). During the beginning of
Occupation during the pandemic the pandemic, many parents reported their adolescent
Labourer 3 15% children often do physical activity with other family
Lecturer 2 10% members, such as cycling and morning walks, particu-
Housemaid 1 5% larly during weekend days. The majority of parents also
Tailor 2 10%
stated asking their children to help them with domestic-
related physical activity, such as cleaning the house and
Teacher 6 30%
gardening. Few parents facilitated their adolescent chil-
Entrepreneur 3 15% dren to continue their training in sports clubs once they
Housewife 1 5% opened.
Multi-Occupation 1 5%
Unemployed 1 5% “ … for example, her little sister when doing mm …
Gender of the adolescent children
dance then she was also following to dance in the
living room” (P13, parents of 14 years old female
Female 9 45%
children).
Male 11 55%
Age of the adolescent children (years old) Moreover, having friends around the house supported
12 3 15% adolescents to be active during the pandemic, especially
13 6 30% for males. Many male adolescents were reported often
14 5 25%
going out for physical plays with their friends, such as
playing soccer, because they felt more relaxed or not too
15 6 30%
afraid of the pandemic. Meanwhile, many mothers re-
ported that their daughter felt reluctant to play outside
of the house, even though they had friends around the
“His dream is wanting to be a part of the national house, as they were more afraid to be exposed to the
team”. “(He) asked how much salary of the national COVID-19 virus. Adolescents also did a regular physical
team?” (laughing) (I: laughing, yup). “It makes (him) activity as a part of assignments from teachers for Phys-
so excited to volleyball, (he) loves it very much” (P4, ical Education lessons. While support from othersAndriyani et al. BMC Public Health (2021) 21:1864 Page 6 of 14
Fig. 1 Factors affecting adolescents’ physical activity during the COVID-19 pandemic
seemed to facilitate adolescents to do more physical ac- participating in extracurricular activities. Most children
tivity during the pandemic, the majority of mothers felt did only engage in screen time in the late afternoon and/
that their adolescents’ do more physical activity before or evening for a limited time as they need to go to bed
compared with during the pandemic. early to prepare for school the next morning.
However, parents reported a sharp increase in chil-
The availability of physical activity facilities and equipment dren’s screen time during the pandemic. Educational de-
The majority of mothers reported that the proximity of mands appeared to be one of the main factors driving
physical activity facilities around the house, e.g., badmin- this. All parents reported that doing online study at
ton field, free open space, affected their children’s in- home makes their children access screen-based devices
volvement in physical activity. The options for physical much more; their children were allocated many assign-
activity remained limited as the majority of public sports ments and did study primarily by using screen-based
facilities, such as swimming pools and sports fields, were devices.
closed. Few parents reported that having physical activity
equipment at home, such as a treadmill and a stationary “Screen use during the pandemic is for online study,
bicycle, made their children do more physical activity she spent quite a lot of time in front of a screen be-
during the pandemic. cause having a lot of assignments” “ … . in the begin-
ning (of online study), in a day (she can do) 6 hours,
“Yes, there is a badminton field near our house (I: only stopping for eating and praying” (P10, parents
Yup). Kids always played there in the afternoon. of 14 years old female children).
Sometimes he played there together (with his
friends)” (P8, parents of 12 years old male Interviews revealed that WhatsApp became the main
children). platform for the school’s work. Children needed to ac-
cess the school’s WhatsApp groups regularly to check
Factors affecting adolescents’ sedentary behaviour during updates, information, and assignments from their
the COVID-19 pandemic teachers. Children also used this platform to communi-
Educational demands during the pandemic cate or discuss assignments with their friends.
Before the pandemic, parents reported that children
used screen-based devices for a quite limited time during “His Dad bought a smartphone for him because
school days. This was mainly because children spent there are school’s WhatsApp groups that he used
most of the daytime at school, especially those for...mm for (checking) school’s assignments. So, theAndriyani et al. BMC Public Health (2021) 21:1864 Page 7 of 14
Fig. 2 Factors affecting adolescents’ sedentary behaviour during the COVID-19 pandemic
assignments were sent to students through What- escape” (P6, parents of 13 years old female
sApp” (P15, parents of 15 years old male children).
children).
“Because of boredom (I: Yep) What else to do if not
Parents also reported that their children often accessed using a smartphone?” (laughing) (P8, parents of 12
YouTube for educational purposes. Children look for years old male children).
educational information by watching videos on YouTube
platforms or upload videos on YouTube as a part of the Other psychological drawbacks that children felt during
school’s assignment. the pandemic seemed to be caused by educational de-
mands, which resulted in some stress and emotional dis-
Psychological effects due to the impact of the pandemic turbance for adolescents. This also seemed to increase
Children’s activities appeared to change drastically dur- their need for recreational screen time. For recreational
ing the pandemic. The majority of parents indicated purposes, adolescents were using a smartphone much
their children had some problems in arranging their ac- more than watching TV. Mothers mentioned that car-
tivities. Having become accustomed to school routines, toon or animation programs had become their children’s
most children were reported to be confused about what favourites. Watching videos on the YouTube platform
to do at home. Because of requirements concerning so- on a smartphone were also popular. This might be
cial distancing and quarantining/isolating, children were caused by various options that are offered and can be
encouraged to stay at home, especially in the early phase chosen based on the children’s interest and being access-
of the pandemic, which mostly closed their access to the ible almost at any time. Many mothers of male adoles-
outside world. Parents reported that this situation put cents mentioned that their son also used their
some mental pressure on children and most of them smartphone heavily for playing games.
then simply engaged for long periods of time in recre-
ational screen use. This seemed to be to escape from the Devices and internet availability
situation or to cope with boredom. The availability of the devices, such as a smartphone
and television (TV), and internet access during the
“Doing nothing at home is impossible, right? (I: Yep) pandemic, influenced children’s screen time signifi-
(she) then watched TV and used a smartphone to cantly. All parents reported that they facilitated theirAndriyani et al. BMC Public Health (2021) 21:1864 Page 8 of 14
children’s learning during the pandemic by providing period, right?” (P10, parents of 14 years old female
smartphones. Most parents reported having a TV at children).
home and some provided a TV in the child’s bed-
room. All parents also provided internet access; the Concerning controlling facilities, many parents stated
majority of them facilitated internet access by buying that they did not provide the use of Wi-Fi at home and
internet quota from a mobile data provider; only provided a certain internet quota for a certain time to
some parents facilitated the use of Wi-Fi at home. limit screen exposure in their children. These parents re-
Some parents reported that there is free Wi-Fi for ported that these strategies were quite useful to make
the community near their house and that they some- their children became more considerate in using their
times permitted their children to go out to access smartphone.
this.
Although all parents expected that children used the “Yes, and we limit her in using it (internet quota)
device mainly for education, it cannot be denied that the only for important matters. Because I checked the
majority of children also used the device a great deal for data usage. (Internet quota) should be used for cer-
recreational and social purposes after or in between tain days. If (it) often run out, it means not for that
doing their school work. The availability of electronic (education). So, they already knew and able to man-
media equipment, such as TV and smartphone, in the age. “If I often run out internet quota then it means
bedroom also facilitated children for more screen I did like this”, she already knew. I gave certain
exposure. (internet) quota, like twenty thousand (Indonesian
rupiah) for some days” (P19, parents of 12 years
“At night (he) switched off (the TV) and sleep, but old female children).
when I have slept the TV was on again” (laughing)
(P12, parents of 13 years old male children). Lastly, regarding allocating non-screen activities, many
parents reported that asking children to help with do-
Parental control mestic tasks was quite useful to help their children be
Mothers’ stories revealed that adolescent children away from the smartphone, although temporarily. There
were given more trust to manage their own time, was no clear difference in domestic tasks between female
thus they became more independent in doing so and and male children. Many mothers stated that their male
choosing their screen-based activities. However, the and/or female children helped them either to clean the
majority of parents tried to apply some control of house, wash clothes, dry clothes in the sun, iron, water
their adolescent children’s screen use by setting some plants, or helped them in the kitchen, such as cooking
rules, controlling facilities, and allocating non-screen rice and boiling water.
activities. Parents’ working location seemed to greatly influence
Firstly, regarding rules, the majority of the parents their ability to control children’s screen time. Working
tried to limit the duration of their children’s screen outside the house during the day made many parents
time, especially in the evening. Many mothers, who have less control over children’s activities and screen
acted as the gatekeeper of children’s screen use in the time. Parents who work outside the house admitted that
family, reminded their children anytime they felt their they did not exactly know their children’s activities at
child used screen-based devices for too long. No spe- home during the pandemic.
cific explanation about the duration of “too long” was
evident as it appeared to be based mainly on parents’ “Kind of less attention (I: Yup) I work and go back
feelings. However, many mothers admitted that there late afternoon (I: Yup) Less control (toward him)”
were times when their children were not willing to (P11, parents of 14 years old male children).
follow the rules and asked to use the devices for lon-
ger. Support from fathers to apply screen time rules
seemed to facilitate a reduction in children’s screen Social facilitators
time. Family members and peers appeared to have a signifi-
cant contribution to adolescents’ screen time during the
“Mm … of course, there were barriers because some- pandemic. Many parents stated that their children often
times depends on the mood. Kid’s mood if (she) watch TV together with other family members, such as
wants to follow rules then (she) follow rules. If not in their siblings, during the day for their favourite pro-
a good mood then, how to say it? Mm … kind of grams. This was not the case before the pandemic as the
(pause) maybe now we call it to rebel, that hap- adolescent children spent most of the time at school
pened, because the adolescent period is rebellious during the day.Andriyani et al. BMC Public Health (2021) 21:1864 Page 9 of 14
Moreover, peers also influenced screen exposure in factor for maintaining participation in physical activity
children. As children met their friends more rarely dur- [46, 47], although conceptually, the construct of enjoy-
ing the pandemic, it can be understood that they wanted ment is sometimes complex (see [48]).
to stay connected with their friends through social media However, few adolescents clearly showed that their
platforms. WhatsApp and Instagram have become the self-determination to do physical activity was also influ-
most accessed social media by children. Overall, girls enced by incentives concerning what they want to
seemed to be more interested in using social media for achieve. This is consistent with Bandura’s social cogni-
chatting than boys. tive theory which posits that behaviour is determined by
expectancies and incentives, such as obtaining an ‘ideal’
“So, she usually chats with her friends, like for prep- body shape and gaining economic benefits [49]. Inter-
aration mm … what program they want to present? ventions for increasing adolescent physical activity may
Like (pause) who will present for this program? (for) need to consider how to develop participant’s self-
discussion, discussion forum” (P10, parents of 14 determination by ensuring that the program offers en-
years old female children). joyment and emphasizes the incentives that participants
can get, such as good health status and satisfying phys-
ical appearance.
“Yup, he is not keen on chatting with his friends, he Secondly, in line with previous studies [50–53], we re-
rarely checked (WhatsApp)” (P3, parents of 13 vealed that support from family, friends, and teachers
years old male children). seemed to affect adolescents’ physical activity during the
pandemic. A recent longitudinal study also found that
Specific for the male children, having friends with the parental support was positively correlated with MVPA in
same interest in playing online games facilitate them to youth [54]. As Granich et al. [50] pointed out, role mod-
do more leisure screen time. Male children’s activities in elling and reinforcement from parents have become im-
playing online games seemed not only for leisure but portant factors for influencing children’s behaviour.
also to facilitate social connection within their male Parents’ support for adolescents to join sports clubs,
friends. such as providing transportation and sports equipment,
has facilitated adolescents to be physically active. Mean-
“There was influence from his friends. Everyone plays while, siblings facilitated adolescent’s physical activity by
online games, they play (online games) together. His increasing opportunities for adolescents to engage with
friends have Wi-Fi at their house, so they sometimes different types of physical activity, such as free play [50].
made an appointment, not gathering together in one Peers have also been found to be important facilitators
place, but sometimes (they played together) at their for adolescents’ physical activity during the pandemic.
own house, but already made an appointment” For example, adolescents tended to be more involved in
(P20, parents of 15 years old male children). greater intensity of physical activity when getting to-
gether with their peers [47, 52, 55]. Friends provided
Discussion support by co-participation, role-modelling, giving verbal
This study aimed to investigate mothers’ perceptions of encouragement, and increasing enjoyment in doing
underlying factors affecting changes in physical activity physical activity [46, 47]. Moreover, teachers provided
and sedentary behaviour in adolescents during the supports on physical activity through Physical Education,
COVID-19 pandemic. We identified three themes re- both before and during the pandemic. Taken together,
garding factors associated with changes in physical activ- physical activity interventions in adolescents should con-
ity during the COVID-19 pandemic. Firstly, this study sider involving family, friends, and teachers in imple-
found that self-determination and enjoyment seemed to menting the programs.
be one of the main factors affecting physical activity Lastly, regarding the availability of physical activity fa-
positively in adolescents during the pandemic. Self- cilities and equipment, this study revealed that these fac-
determination to do physical activity may be influenced tors supported adolescents in doing more physical
by the need to grow [45], such as wanting to be an elite activity during the pandemic. Aligned with this finding,
athlete, or because of having intrinsic motivation [45], a previous systematic review found that there was an as-
such as doing physical activity for enjoyment. Enjoyment sociation between physical activity behaviour and the
appeared to play an important role in supporting self- presence of physical activity equipment at home [56]. In-
determination. Being highly self-determined to do phys- creasing the availability and accessibility of physical ac-
ical activity may be simply started from the enjoyment tivity facilities in open spaces close to community
that someone felt when engaged in physical activity. Pre- settlements may trigger adolescents to do more physical
vious studies have found that enjoyment is a significant activity and reduce their overall sedentary behaviour.Andriyani et al. BMC Public Health (2021) 21:1864 Page 10 of 14 We generated five themes concerning sedentary be- shorter sleep duration and decreased sleep quality haviour. Firstly, this study found that demands for [65, 66], especially close to bedtime. Screen use that online-based learning during the COVID-19 pandemic involves active engagement before bedtime may dis- have caused a significant increase in adolescents’ screen turb the ability to sleep as that activity may cause time. The reasons children used more screen-based de- physiological and psychological arousal [65]. vices for online study is obviously associated with the In addition, physical distancing and quarantining mea- creation of much greater demands for this type of deliv- sures that were implemented during the pandemic have ery of teaching and learning during the COVID-19 pan- caused a significant reduction in physical activity and a demic. Moreover, it may be partly explained by using clear increase in electronic media use [23, 61, 62, 67]. the concept of extrinsic motivation, such as when ado- Participation in the physical activity itself is important lescents completed assignments to avoid punishment or for maintaining good mental health [68, 69]. Meanwhile, low marks [57]. Furthermore, it may be caused by the excessive recreational screen time has been associated need to fulfill basic psychological needs, especially com- with poor psychological well-being [70–72]. petence [57]. As one of the primary psychosocial tasks However, not all recreational screen time causes nega- that adolescents must achieve is ‘to measure up’ – that tive effects on young people. When done appropriately is to develop competence and find ways to achieve the and moderately, it may bring positive effects as it can goal [58]- it has become the nature of adolescents that boost mood and provide enjoyable recreation. This is they want to show their capability, skills, and compe- consistent with previous studies that recreational screen tence, such as by performing well in finishing school as- time may result in both positive and negative effects, de- signments. These necessitate studying through the use pending on how children use it [73]. Screen use might of internet-connected devices. provide social benefits by enabling communication While adolescents spent much greater screen time for within friends, provide emotional satisfaction and relax- educational purposes during the pandemic, this might ation, such as from watching humorous content, but not necessarily cause the adverse effects as if the screen may also be detrimental to emotional health, such as time were used for recreational purposes. Sanders et al. causing depression from experiencing cyberbullying [73]. [59] found that types of screen use moderated outcomes Given the ubiquitous nature of contemporary screen use, of screen use. For example, educational screen time had it is important to recognise the positive as well negative a positive correlation with educational outcomes and uses. Strategies to reduce recreational screen time, there- higher persistence, with no negative consequences for fore, should also include education on healthier recre- health outcomes. Nevertheless, consistent with inter- ational screen time to minimize adolescents from getting national guidelines, it is suggested that adolescents break negative effects from screen-related activities. This ap- up prolonged sitting when studying to avoid any health proach can be incorporated into the most popular pro- risks that may arise from static postures and lack of grams and platforms for adolescents, such as cartoon and movement. YouTube, and should improve awareness of the psycho- Secondly, this study found that adolescents did experi- logical, behavioural, and physiological effects of excessive ence some negative psychological outcomes, such as screen time [50] as well as the benefits of physical activity. stress and boredom, during the pandemic. These seemed Thirdly, consistent with previous studies [50, 56, 74, to facilitate them consuming more recreational screen 75], we identified that the availability of screen-based de- time. This is consistent with previous studies that found vices and internet access has influenced adolescents’ that the COVID-19 pandemic has created mental health screen time significantly. Having internet access always problems in adolescents, including high anxiety rates, available on a smartphone, either from a mobile data concentration difficulties, depression, and reduced hap- provider or through Wi-Fi, appeared to increase adoles- piness [60–62]. Stierlin et al. [63] found a similar result cents’ opportunity to surf the internet anytime and any- that youth with more mental health problems tended to where. A recent study by Thomas et al. [73] showed a have greater screen time. similar finding that internet access availability facilitated The root cause of psychological problems that were adolescents to spend more time on screens. experienced by adolescents during the pandemic may Previous experimental studies found that limiting ac- come from sleep deprivation [64]. Suggestions to stay cessibility toward screens has successfully reduced indoors during the pandemic may have caused a re- screen exposure in children [56, 75]. Thus, future inter- duced exposure to sunlight, which is essential in vention studies aiming to reduce adolescents’ screen maintaining a regular sleep routine [23]. Moreover, time may consider limiting accessibility toward elec- the excessive use of electronic media, especially for tronic media equipment at home, such as limiting the social media or internet use and playing online permitted duration at certain times of the day [76] and games, had been found to have an association with allocating specific rooms to use the devices.
Andriyani et al. BMC Public Health (2021) 21:1864 Page 11 of 14
Furthermore, our study revealed that parental control sedentary behaviour during the COVID-19 pandemic,
is likely to influence the length of adolescents’ screen especially in LMICs. The heterogeneous nature of the
time. A previous study found similar results whereby participants’ demographic background has enabled the
rules and restrictions for using electronic media moder- researchers to gather a range of stories, opinions, and
ated the duration of children accessing screen media experiences which add to the richness of the data. More-
[50]. Our study also found that mothers tend to be the over, the semi-structured interview format allowed the
dominant gatekeepers of adolescents’ screen use. There- interviewer to probe for more information and gather
fore, it may be important to involve mothers, as well as deeper insights on the interview topics. Having personal
other family members, in interventions to modify adoles- connections with some participants and sharing similar
cents’ screen time. Promotion of current guidelines on cultural backgrounds with all participants also have
sedentary behaviour in adolescents, such as the 2020 helped the interviewer in building rapport during inter-
WHO guidelines on sedentary behaviour [77], is also im- views, which may help in facilitating the participants to
portant to increase parents’ awareness on how to guide share their true stories.
screen use for their children. Other guidance also exists Limitations of this study include the sample from one
[78]. Nevertheless, the process of modifying behaviours region of Indonesia, therefore findings may not be true
in adolescents should also consider other internal factors for other regions in Indonesia and other countries.
within adolescents that motivate them to accept and Nevertheless, it is consistent with the objective of the
change their behaviour [50], such as self-efficacy. Involv- qualitative study that has no aim to generalise its find-
ing adolescents in such decisions is important. ings to other populations. Moreover, it is undeniable
Lastly, aligned with a previous study [50], the current that some participants may feel some hesitation in tell-
study suggests that family members and peers are found ing all stories due to social desirability bias. Participants
to be social facilitators that affect screen use in adoles- may also have limitations in providing immediate re-
cents. Peers appeared to influence adolescents’ screen sponses to some questions and forget some details of
time through social media and online games. Adoles- their stories and views.
cents seemed to try to stay connected with their friends
through these platforms and to fulfill one of their basic Conclusions
psychological needs, that of social relatedness [57], and This study provides new insights on possible underlying
the psychosocial task to fit in – “to find comfortable af- factors affecting changes in Indonesian adolescents’
filiations and gain acceptance from peers” [58]. physical activity and sedentary behaviour during the
WhatsApp and Instagram have become popular social COVID-19 pandemic. Overall, adolescents appeared to
media platforms accessed by adolescents. Therefore, fu- become less active and more reliant on screen-based de-
ture interventions to promote physical activity and to re- vices, either for educational or recreational purposes.
duce excessive sedentary behaviour may need to WhatsApp, Instagram, YouTube, and cartoons were the
consider using these applications and other recent popu- most popular social media and programs. Future studies
lar applications among adolescents in implementing and policymakers should account for these findings
their programs. While it may seem ironic to use screen- when considering interventions and policies.
based platforms to change screen use, it may be a suit- Future studies aiming at increasing physical activity
able and practical strategy if used properly (see [76]). and reducing sedentary behaviour in adolescents should
Regarding adolescents’ active involvement in playing consider increasing parents’ and adolescents’ awareness
online games, it may be important to make recommen- of current activity guidelines, the risks of excessive sed-
dations on the types of games that may facilitate physical entary behaviour, and providing education on healthier
activity, psychological health, social interaction, and col- recreational screen time. Involving parents, peers, and
laboration with others [79]. However, it is important to teachers, as well as the adolescents themselves, in inter-
bear in mind that excessive gaming may cause detrimen- vention programs may provide substantial benefits.
tal effects for adolescents, including excessive sedentary Moreover, physical activity intervention programs for
behaviour, sleep deprivation, physical aggression, depres- adolescents should consist of activities that are enjoyable
sion, and academic problems [80]. Therefore, providing and satisfying, with an increase in the number and range
education on appropriate gaming for adolescents seems of physical activity facilities and equipment accessible
to be important. near to community settlements being important.
Strengths and limitations Abbreviations
A strength of this study is that it adds evidence to the WHO: World Health Organization; MVPA: Moderate-to-vigorous physical
activity; COVID-19: Severe acute respiratory syndrome coronavirus 2 (SARS-
limited qualitative literature examining factors likely af- CoV-2); LMICs: Low-to-middle income countries; SRQR: Standards for
fecting changes in adolescents’ physical activity and Reporting Qualitative Research; TV: Television; I: Interviewer; P: ParticipantAndriyani et al. BMC Public Health (2021) 21:1864 Page 12 of 14
Supplementary Information Physiol Nutr Metab. 2016;41(6 Suppl 3):S283–93. https://doi.org/10.1139/a
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